Brief Answer:
Migraine vs. CGH? Neurology examination worthwhile

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a neurologist and headache sub-specialist from XXXXXXX OH. I'd be happy to address this question for you. It would be nice to know your symptoms of headache that you suffer so that we may try and RE-define them and VIRTUALLY diagnose your type. So, can you tell me a brief summary of the following:

1. Do you have any or all of the following symptoms either before, during, or after your headaches?- Light, sound, smell HYPERsensitivity which makes headaches clearly worse, nausea/vomiting, throbbing one sided pains of the head which are severe and get better with staying still and being in a dark, quiet room and tend to go away with sleep- Duration of headaches untreated is between 4-72 hrs. Generally not more than 1 episode at a time. Are there warning signs to the headaches which precede them by 5-60 minutes?

If you can answer any of those questions for me then, we can better characterize your headaches as MIGRAINOUS or likely MIGRAINE vs. not.

Also, please tell me what your best evidence would be to support the concept of YOUR headaches being caused by a cervical fusion procedure. Did you have ANY TYPE of headache AT ANY FREQUENCY before the procedure? Did you have bad or even medium types of headaches as an adolescent or child? How about menstrually initiated or predictable headaches?

Finally, is it that your doctor wants you to have a neurological exam to solidify the diagnosis of migraine headaches no matter the cause; to ground the diagnosis of migraine headaches as being related to or caused by the fusion procedure; or is it for none of those reasons? Perhaps, there is a new neurological finding your physician is noticing that they wish a neurologist to comment on?

2. CERVICOGENIC Headaches- This is a type of headache (which is not REALLY a headache) and is rarely diagnosed. It is also one of the most difficult to successfully to treat because of the fact that, as its name implies, the headaches are ultimately caused by some kind of pathology within the cervical spine and thus pain emanates from there, radiating upward in what we would call a radicular pattern that may eventually result in a very bad, bad headache.

I'd like you to look at the following video shown at this link and see if any of your symptoms are similar to what the doctor is describing as being the major mechanism by which these headaches occur as well as how it presents as well as the risk factors associated with this headache.

http://www.spine-health.com/video/cervicogenic-headache-video

In point of fact I would tend to agree with your doctor who believes a neurological examination is worthwhile because of migraines, not because there is an expectation that something odd or unusual is likely to be found in the brain but rather to verify the type of headaches and the likelihood that they should or are related to the spinal fusion procedure. Remember, it is true that headaches such as migraines can co-exist with other problems and either be related or unrelated. They can be clearly as a consequence of a precipitating factor or entirely coincidental. Sometimes it can be very tricky, even for an experienced headache specialist to know the differences between these headaches types (as in this case migraine vs. CGH) as well as their causes.

If this information has been at all helpful in answering your question I would appreciate a small bit of written of feedback as well as a STAR RATING.

Also, if you have no further comment or question in this thread would you consider CLOSING THE QUERY on your end which will signal to the network that the case is ready to be processed, archived, and credited/recorded for future reference.

Please feel free to contact me in the future on this case or any other by writing direct questions to me using the following link:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This query required 88 min. of physician specific time to review, research, and provide final draft documentation for envoy.

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Brief Answer:
A neurologist's opinion is worth obtaining

Detailed Answer:
Good evening. Thank you for your updates.

And so it appears in fact you do have a history of headaches that were severe and given the age they started were likely of the migraine type. Perhaps, some headaches were menstrual headaches as well. The knowledge of hysterectomies curing headaches is about as accurate at menopause curing headaches. Neither have a consistent nor predictable track record in performing that little miracle but somehow the public (and also many physicians have been brought to believe those concepts). WORSENING headaches after cervical fusion is different than your cervical fusion CAUSING your headaches which is what you stated in your original question. Therefore, CGH as I described above may not be entirely accurate as a headache type although I'm sure a form of cervical radiculopathy which is contributed to by the surgery certainly can trigger headaches. Another trigger of your headaches appears to be cold weather and it is possible that you are now describing another headache type referred to as BAROMETRIC HEADACHES which are initiated by changes in weather fronts and conditions. The nasty thing about those headaches is that they "get you coming and they get you going!" Am I right? In other words, as the weather system or change settles in town...you feel rotten and when the weather system clears out and there is a change (whether good to bad or bad to good) you still feel crummy. Is that correct?

So, in conclusion you may have the following headache types present at the same time:

1. History of adolescent migraines +/- history of menstrual migraines which never cleared following hysterectomy.

2. Cervical radiculopathy which resulted in a cervical fusion and this more likely contributes to headaches though it is unclear whether these are truly CGH's or not.

3. Barometric Headaches

And not to be any more complicated than necessary but I didn't even get into asking you the full history on other aspects of your history and how you approach treating these headaches in terms of medications you are taking (either prescription or Over The Counter), family history, and other lifestyle parameters such as smoking, caffeine intake, and diet which we know strongly influence the precipitation of as well as worsening of headaches.

So, even as a headache specialist I can tell you that this is a CHALLENGING picture to organize and attack let alone if one is a non-neurologist. Your doctor realizes that there are a lot of moving parts to this picture and in my opinion is rightfully waving the red flag and asking for help.

If I were in your position I would really like someone on consult who is not only a good neurologist but headache specialist with creative ideas as to how to approach these problems simultaneously.

Need I say more to convince you that a neurology examination would not only be a good idea but I might say your primary doctor were being almost lackadaisical in your care if he/she didn't ask for the consultation.

Please let me know how things go.....as I've said to you before I am a headache specialist used to treating these types of complex pictures in people who have had severe and ongoing problems for decades at a time. I'd be happy to lend a hand in helping guide your neurologist if in fact the person you end up seeing is not a headache specialist themselves.

If this information has been helpful in answering your question I would appreciate a small bit of written of feedback as well as a STAR RATING.

Also, if you have no further comment or question on this thread would you consider CLOSING THE QUERY on your end so that the case may be processed, archived, and credited/recorded for future reference.

Please feel free to contact me in the future on this case or any other by writing direct questions to me using the following link:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This query required 23 min. of physician specific time to review, research, and provide final draft documentation for envoy.

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